Attorneys for Prudential Disability Claims
- Prudential Disability Benefit Denials Are Common
- Prudential ERISA Disability Lawsuits
- Prudential Long Term Disability Denial Reversed for IT Professional with Cancer
- Prudential Disability Insurance Claim Denials Resulting In Lots of Appeals & Lawsuits
- Prudential Disability Insurance Claim Trends, Lyme Disease and Neck Disorders
- Prudential Long Term Disability Insurance Claims (Ep. 8, part 2/2)
- Prudential Disability Insurance Benefit Denial Not Subject to 24 Month Mental Nervous Limitation
- Prudential Disability Insurance Buyout or Lump-Sum Settlement
- If Fired From My Job Can I Still File for LTD Insurance Benefits?
Our disability lawyers have thousands of hours of experience in handling Prudential disability claims on behalf of claimants. We handle everything from the initial application for disability benefits, ongoing claim management, first and second level ERISA Appeals, lawsuits in any federal court nationwide and Prudential lump-sum buyout offers.
Our experience against Prudential includes the prosecution of a nationwide disability class action, depositions of numerous Prudential employees (including the VP and Director of Claims), and hundreds of appeals and lawsuits resulting in payment of benefits to our clients. There are very few law firms, if any, that can match our nationwide experience and knowledge with regard to Prudential.
Prudential only sells group disability insurance policies, therefore more than 95% of their policies are governed by the horrific ERISA laws. We suggest you watch our numerous videos discussing ERISA disability claims.
Prudential Loves To Use Video Surveillance To Deny Claims
In more than 80% of the disability claim denials our firm has reviewed, Prudential has relied upon secretive video surveillance of a claimant in order to support their claim denial. It appears that the Prudential claims examiners have been trained to think that if a person is seen doing an activity on video for a few minutes, then that must mean they could return to work for 8 hours / 5 day a week.
Prudential claimants need to be aware that Prudential will spend thousands of dollars on video surveillance and they will often do it several times a year. We are routinely contacted by Prudential claimants that have been denied benefits after being paid for 8 years or more. We were recently contacted by a 61 year old woman that was denied after receiving payment for 18 years due to a brain disorder.
You can never let your guard down when dealing with Prudential and a claimant must always be proactive in order to protect continued payment of benefits. In addition it is common for Prudential to send misleading letters to a claimant’s treating physician which often result in a claim denial.
Free Prudential Disability Insurance Information For Claimants
Our disability attorneys believe that a claimant has a better chance of ensuring continued payment of benefits if he or she is educated about Prudential’s disability claim handling activities.
You may find it helpful and educational to watch our Prudential disability videos, read the comments and complaints posted below by Prudential claimants, review some of our resolved Prudential cases, and read our summaries of Prudential lawsuit and court decisions throughout the United States.
We hope that you find some of this information helpful and we welcome the opportunity to discuss your Prudential claim with you.
Does Prudential LTD insurance have annual cost of living increases? SSDI benefits do. I will receive benefits from Prudential for the next 12 years, but if there are no annual increases, I will not make it financially.
Dan,
Most Prudential long term disability policies do not provide for cost of living increases. If you have a cost of living increase, then it will say so in your disability policy.
After receiving LTD payment for over 2 years Prudential stopped payments claiming my doctor did not fill out Residual Functional capacity questionnaire. Prudential informed me of their decision 4 days prior to my normal monthly check date via telephone. Prudential claimed they did not call me in regards to incomplete paperwork because “by law” they can not make the doctor fill out the form. I hired an attorney and won at the first level of appeals. Of course attorney charged me a fee to handle case. Could I sue Prudential for the money I paid to my attorney, considering I was forced to wipe out my 401K, fell behind on rent and almost evicted as well, having to use charity care for ER visits and was unable to pay for needed medical treatment for my disability?
Nicole,
I am glad to hear that you were able to win your Appeal against Prudential. Unfortunately the law does provide for any attorney fee award at the Appeal stage. Due to the limitations of ERISA you cannot sue Prudential for any of your damages. You can only sue Prudential for disability benefits, interest and attorney fees if you were to lose your Appeal. ERISA is not a fair law. You should take a look at the numerous videos we have posted on our site discussing ERISA. You need to spread the word about how unfair ERISA is and help to make your legislator change it.
I think it is terribly unfair that I have paid premiums for short and long term disability through my employer, after being in the work force for over 30 years, and Prudential demands doctors reports on a month to month, or better, basis and expects this is timely manner. Yet, they do not respond in timely manner. Not only do they not respond, but they lie, and ask for medical documentation already given to them, to just stall paying benefits. If I could work, I would, as it is better than dealing with them. I wish I was not ill and could work, in all honesty. They are overwhelming me as I am head of household and with no income, it is not easy here. Totally unprofessional, no heart, and I just do not understand how they have the right to treat me like this.
Cynthia,
Disability insurance benefits are a month to month evaluation. You need to keep up with Prudential’s request or they will deny your claim. They have a right to make all of the request they are making. We represent claimants with the monthly claim handling process so that the claimant does not need to communicate with the disability insurance company. You can watch our video about monthly claim handling here.
Prudential hired Allsup on my behalf to file for SSD. Allsup does not charge the client any money if SSD awards retroactive benefits. After working with Allsup through 2 appeals with SSD, Prudential informed Allsup they were no longer paying for their services because Prudential did not feel I was still disabled. I hired attorney to handle my LTD denial and won. During the appeal process of LTD I decided to go with an SSD attorney from the same law firm with standard 25% fee or $6,000. Months after my LTD benefits were reinstated Allsup called me again to say NOW Prudential was willing to pay for their services again. But at that point I had already hired an SSD attorney. I am required to repay Prudential any retro pay if I win SSD? But what about the SSD attorney fee that I have to pay?
Nicole,
You are not required to pay Prudential for the $6000 SSDI attorney fee you paid.
I find Prudential Insurance Company to be an absolute disgrace when it comes to handling cases for their clients with disabilities. It has been my experience that they are untruthful, harassment of their clients with the with the excuse that they are not receiving the information they are requesting. Also phone calls are not returned which, in my opinion, is unacceptable and unprofessional. Dates for settlements are constantly changed, leaving their clients holding the bag with no means of support either financially of emotionally.
I was denied Prudential LTD benefits after missing a reassessment hearing that was required because Prudential’s doctors did not feel I was still disabled. However, two months later Social Security granted my disability using the same medical opinions Prudential had. I was so fed up with how Prudential handled my case that I just didn’t appeal. After reading comments from others I am beginning to believe this happens all the time. My question is, can Prudential cancel or deny your claim if you are approved for social security disability benefits? Had I appealed, would I still be hostage to meeting there satisfactory guidelines for disability while receiving Social Security Disability Benefits?
DeeJay,
If the appeal deadline has not passed, then you should still appeal ASAP. Prudential is not bound to follow the SSDI guidelines and frequently an SSDI approval does not mean that the LTD carrier will pay you. Please see our video discussing your situation.
I have been disabled since August 3, 2009 when I had a TIA while at work. That was a Monday morning. That Friday morning I had another TIA while at home still recovering from the first one and was rushed to the hospital unresponsive. To date I have had 4 more, most recently on September 5, 2012. I have had Prudential long term disability benefits for the past 3 years since my short term disability benefits ran out. Around the same time my long term benefits started, Prudential hired Allsop to apply for Social Security Disability for me, which I was awarded on the first attempt. I have been to many different types of doctors during the first year or so as recommended by my neurologist in an attempt to diagnose or find a cause for my having the TIA’S, but none of them were successful. I have also been through months of testing for cognitive functioning ability by a neuropsychologist and I have tested extremely poor on all of the different types of tests. I also have extremely poor short term memory and I’ve lost the ability to do some things such as simple math and filling out forms.
My background is in the medical field. I was an EMT and an RN and I had to leave patient care years ago as my whole lumbar spine is injured with herniated and bulging discount and I couldn’t lift patients anymore due to the constant severe pain. I didn’t even consider disability then, but I went to work for a pharmaceutical company and I was working as a case manager in clinical trials for chemotherapy drugs and compounds.
This is what I was doing when I had the first TIA in my office in Aug 2009. At first I thought Prudential was a wonderful company and I was very grateful for having them for my long term disability benefits, but over the past year or so I honestly think they are trying to kill me. They have changed my claim manager many times and I never know who is currently managing my case. I also have been getting reviewed every couple of months where at first the reviews were twice a year. I find out that my claim was not approved by not receiving my check at the end of the month, which is extremely stressful every time this happens. My claim was again not approved in Aug 2012, and after several phone calls my current claim manager reversed that and told me that I should not have to go through this again for at least 6 months and he was going to try to get my claim permanently approved since my doctors have told them repeatedly that I am totally and permanently disabled.
On September 5, 2012, I had another TIA while sitting in the waiting room at my pain management doctor’s office and I was rushed to the hospital unresponsive again and admitted again. Prudential was notified of this and they asked for a copy of the discharge paper, and that was faxed to them and they said that they would get any other information about this from the hospital and my neurologist.
I was to receive my most recent check on Friday, October 26, 2012, but when I checked my bank account I saw they did not submit the direct deposit again. I called their office in NJ which is where I live and was told that my claim was not approved after September 26th, so I was not going to get my check again. I couldn’t get anyone who could do anything to help me out on the phone and I left a couple of messages for my case manager and his supervisor but no one returned my calls. This left me with a very serious problem since Hurricane Sandy was heading up the coast and was set to make landfall in my home state of NJ. Since I did not get my check I could not get supplies before the hurricane hit and once it did I lost the electricity and I had no running water either since I have a well. I also have all my monthly bills set up with my bank’s automatic bill pay system and now I had no money, electricity, water, or supplies. Fortunately I was able to call the bank’s main office from my cell phone and they canceled all of my automatic bill payments.
Now Prudential is insisting that they have to have all these records from my neurologist and the hospital before they will review my case, and they are ignoring the fact that the doctor and hospital are in NJ, which has been hit the hardest by Hurricane Sandy and has been declared a Federal Disaster Area, and I cannot reach my doctor as I’ve been told that his office is closed indefinitely and I cannot safely drive to the hospital to get the records from them either.
I have been told by many of my claim managers that I have been declared to have a permanent brain injury as well as my other medical problems, and I have been declared to be totally and permanently disabled and I should never have to go through these reviews. But here I am, in the middle of the worst storm in my state’s history, and I have no money and no way to reach anyone who Prudential wants to hear from in order to get my claim reinstated, and since their office is located in NJ also, they know this is true.
I am totally and utterly frustrated and scared. I don’t know what to do or where to go for help. I don’t qualify for anything else because of the disability benefits, but I only get enough money to barely scrape by from month to month and I owe tens of thousands of dollars in medical bills that I cannot possibly pay. What do I do? I need food and medicine and I have to pay the normal household bills. Does Prudential ever declare anyone permanently disabled? I can’t take this stress they are causing me over and over any more. I swear they are trying to kill me.
Nancy,
It sounds ridiculous that Prudential will not release payment to you. You need to call them and demand to speak with a supervisor immediately. If you have any of your recent medical records, then you need to fax those records to Prudential ASAP. Prudential will not consider you permanently disabled, but we have many clients where Prudential has agreed to only review their files either once or twice a year. You may need to find another doctor right away if your doctor’s office will be closed indefinitely.
I feel that after reading all of the complaints and personally experiencing the same type of reprehensible treatment from them that there should be some way to shut these monsters down. I am in the process of preparing my own attack on them and am determined to take them to the cleaners. In the process of fighting these DNA challenged little more than monkey benign claim handlers, I originally was being paid regularly through Hartford. For the entire year of 2012, I have been fighting with them and am now in the process of an appeal while waiting on SSDI approval. During the course of this brutal battle to get any payment at all. The chronic migraines started in February 2010 and have been next to impossible to control since. I have had CAT/MRI scans, been to pysical therapy, tried several different medications and seen a neurologist.
Because of this runaround where they kept stating they were not getting paperwork from my doctor but I am positive they were, I have wiped out my 401k, am in complete financial ruin and suffered a nervous breakdown requiring me to be admitted to a mental facility right before Thanksgiving. I am now diagnosed with a new disability stemming from their appalling handling of this claim called Manic Bipolar Disorder. I do want to add that I have always worked since I was 12, have always been a positive, vivacious person. Now I am little more than a recluse. I do not trust doctors or psychiatrists anymore and the medication they prescribed during the psychiatric stay made me feel depressed while never experiencing this before. The experience has been something not dissimilar to a horror movie and a complete overhaul of my mind.
I am working through this medication free progressing on my own and feel great as long as I am alone or with my spouse devoid of any stressors. I don’t think I will ever be able to work for anyone ever again. I have some very strict, unwavering expectations of anyone who I come into contact and if I detect or hear any type of negativity or an attempt to force control over me, I won’t hesitate to point out that their actions have no effect. This can make for interesting outings and could be potentially dangerous. I now don’t even trust my employer for allowing this to continue after letting them know what was happening. I feel they also are partially responsible for this new diagnosis. I have no idea how this will affect my current claim and if this now would be considered workman’s comp or if I should hold Prudential liable and with what type of suit.
I can tell you that if I didn’t have a mental breakdown when I lost a child to SIDS about 6 years ago, then this company needs to be shut down. I have been emotionally scarred due to their ineptness and constant requests for information with absolutely nothing in return. The final straw was the 7 page interrogation request where they asked several questions I felt are an invasion of my privacy and this is to me, harassment. I really want to take down these vultures and I am considering getting a petition going, contacting the Insurance Commissioner, the Better Business Bureau as well as media involvement and letters to Senators. I am broke, nearly homeless and my children are grown. There will be no settlement because I am prepared to dig in my heels and give them everything I got and I am very angry and much stronger than I was before so this should be interesting. They might have lawyers to drag this out for years but I don’t care, it never would have come to this had they not threatened my survival.
As a SIDS parent survivor who managed to work through the grief and move on to become a successful stock broker only to be reduced to a mentally ill recipient of government assistance is an absolute atrocity and I am determined to make an example of these heartless, profit hungry, sanity thieves. I have improved but I will never be the same but I am hoping that I am able to stop them from doing this to anyone else and I have nothing to lose anymore so it is my new job now to either bankrupt or take over this company. Seems lofty, but I am going to compile all the past dirt I can find and I am thinking of starting an internet access to allow others to join. I refuse to allow them to control me and I won’t agree to be silenced. This is my story, I am going to find some closure by telling my story to anyone who will listen.
My mom always told me if I ate all my dinner, including my vegetables I would get my dessert. I liken this to me working hard all my life and following all the rules to only have my dessert stolen from me. Now I intend to take the whole pie. And I don’t even want the money anymore…
I feel all of your pain. They do not take your word or your Doctor’s word for your claims. It’s like you’re guilty of giving false information until proven innocent. They don’t even believe the Dr.’s. To give a little insight on my claim I had to have some major work done on my right foot. I had to be completely non weight bearing for 6 weeks. 1st 3 weeks was the healing process until stitches could come out & the next 3 in a cast. When he took the cast off I had an infection that has set up in a 4″ incision in the side of my foot therefore could not walk still “just removed the cast” & couldn’t get a shoe on which my employer has a mandatory policy for no open shoes. They expected me to go right back to work on 10hr shifts right then. As someone posted earlier I went through the same thing with “The office never sent us anything” when I had just left the office & the benefits clerk showed me the confirmation page where she sent it in to them. I called these jokers just as soon as I got to my car & we argued for about 30 min. I had not received a check in over 6 weeks. We were struggling financially with a 6 & 12 yr old at home. They had my dr visit dates all wrong. Everything was a mess. I ask immediately to speak to a supervisor because the lady I was talking too was showing no effort or concern to help me though I told her it would be a different situation if the tables were turned. I also informed her this was not a fringe benefit that I paid for these benefits & I wanted my freaking money! Having to depend on them for your money was a complete & utter joke!
Time to vent again. I know it is too late now for any appeal, I tried that for a couple years. I begged, cried, and cried and cried. I paid for Long and Short term disability at the same company for over 30 years. After working as long as I possibly could, I was denied. I finally ,after living on and wiping out my retirement and 401k got my SSD after seeing a lawyer and a judge. I still cry sometime when I think of it and find myself in my current condition. Have had at least 2 more surgeries and take narcotic pain medication every day with very little relief. We are now living in a mobile home. Our whole lifestyle has changed. Living pay check to pay check after nursing for the same company for 30+ years just breaks my heart for my husband and I. We are just late 50’s and are dreams are gone for now. Oh how I wish I could go to work, but most days I can not go to the store. Anyway, I just can not believe that companies can actually do this to people. It could have mad such a difference in my life and Prudential would not have even felt a thing. They could have still built their stadium and every thing.
Cindy,
Thank you for sharing your story… I can only imagine how hard it must be. Although there is no indication that any sweeping reform is on the way that will come that will prevent the insurance industry from acting the way they do; hopefully with enough outcry things will eventually change.
After dealing with this crooked bunch, I plan on having them submit paperwork to me so that I can decide whether or not to pay them the lump sum SSD payment I’ll receive. I may not be satisfied with what they submit, and I’ll not tell them unless they call. I usually let calls roll to voice-mail and call back at my leisure, but may follow Prudential policy of never returning calls. If I keep the lump sum payment, what can these crooks do about it?
Steve,
If you are on claim, they can withhold your benefit check in satisfaction of the over-payment; or Prudential can send you to collections, and in some instances file civil suit to collect the money (although the latter is not a common occurrence).
I had an accident policy through Prudential that should have paid me $298,750 and it was denied. Walgreens had me on 100% disability but I had 6 months to try to come back as a pharmacy manager which I had been for 15 years. I also had an additional policy called Income Protection Plan for Pharmacists and Nurses which should have paid me $7,000 a month for life. I was in an automobile accident that a lady ran a stop sign and ran her Oldsmobile through my windshield and caused the Mercury Mountaineer, 23 foot bass boat and trailer to roll on top of my entire left arm crushing it and impaling it into the metal of the door with shoulder, arm elbow, and entire hand showing 10 fingers. I had to have a Medtronic Neurostimulator placed along my spinal cord with lithium battery to allow electrical stimulation of the entire left arm. I worked for 5 months and was denied both payments even though I was within the six months they said it was a new claim even though the booklet says any new claim will be considered the same claim if within the 6 month period. I am totally disabled and on disability which should entitle me to both claims.
I have been on LTD through Prudential since August of 2012 and have been approved to August of 2014. I just received my approval from SSDI after my 3rd appeal. No award letter yet but, I will get back pay to August 2012. I hired my own attorney. I was never offered the service from Prudential or even knew they worked with attorneys and offer a credit for those fees if awarded back pay. When I informed my case manager that I would be receiving back pay and that they are required to credit my attorneys fees he didn’t know anything about that. I, of course, have asked for a written estimate of what is being taken out of my back pay bit, how do I ensure they give me that credit? I’m afraid they are going to charge me for those fees and in that case I will owe them more than my backpay. I also asked about COLA and he said that would be taken out as well. I thought they could not do that. I feel like I know more than he does about this!
Nikki,
When you receive the Award Letter from the SSA send it to Prudential. The claims person seems ignorant to your question or has misunderstood it. Prudential’s right to repayment of any overpayment will only be based on the base monthly benefit amount received (before any applicable COLA increases) minus any fee awarded to your attorney. You should not be required to payback the money awarded to your attorney, or any increase amount on account of COLA.
I need help. I have worked all of my life, I was making 20 dollars an hour at my job of 13 years. I had to go out because of my back. I went through pure hell to get approved, I got one little check and now they are bugging me for more information from my Dr. I don’t even have health insurance yet, this is something I paid for through my company, my nerves are shot.
Linda,
Please feel free to contact our office to determine how we might be able to assist you. As disability benefits are reviewed on a month to month basis, please be advised that you have an ongoing duty to provide Prudential with information as often as monthly.
Wow, I am so sorry to ALL of you for your situations and have said a prayer for all. Apparently, the boat we’re in is rather large. I’m no different than some of y’all, purely broke and thankful to friends and family who have helped us however they can; blessed to have a husband who can carry our health insurance and at least make a teacher’s salary which is better than nothing!
I was a med-surg nurse until Oct 2010 when my body just exploded. My primary doc gave up on me cause he couldn’t figure it out, so I left his practice and did most of the researching myself, using my neurologist at the time to order the tests and prescribe meds. I’m STILL peeling back the layers now in Nov. of 2013 of the constant struggle to get well enough to be there for my 10 and 12 y/o daughters, plus I’m only 38 and I’m not giving up.
At this point I’ve ended up with fusions of my neck and low back, C4-5-6 and L5-S1, and artificial disc at C6-7. Hysterectomy and breast mass (benign) removal, three rounds of physical therapy, did massage weekly for about a year, and acupuncture. I already had Celiac disease and found out that I have to keep casein out of my diet as well. I have 4 autoimmune diseases, and starting a workup for two more. Found I’ve had narcolepsy my whole life, but with all this going on plus the pain meds and muscle antispasmodics needed, sometimes I sleep a day or two straight. The excessive daytime sleepiness, memory, and thinking is helped a little by Adderall XR, but I can still fall asleep on it and I didn’t tolerate any of the other meds.
Prudential finally gave me LTD after an appeal, but pulled their sneaky trick by sending that Capacity Questionnaire to my neurosurgeon. His nurse filled it out not knowing much about me at all and stuck it under his nose to sign. Said I was ready for duty 40hrs per week with all the usual joys of nursing, even though the PA in that office had just sent me to another Ortho to check out my clavicles that partially dislocate 24/7. Seriously. So the big P received that June 13 and cancelled my benefits that very day. Imagine my surprise when I had pretty much no money in my account on payday and FINALLY received a letter telling me what happened on JULY 1st GRRRR. They didn’t even type up the letter until June 24th. So, no steak for us :(
I sent my appeal with 7 pages typed by me (took two weeks to do that with my thinking problems and sleepiness) and the rest COMPLETELY UP-TO-DATE notes, tests, etc. 108 page fax. And of course the guy assigned to me called me a week later to ask all the dumb questions that were in my letter and documents. So we played the game of “we need more information” until about two weeks ago.
At that point is when I asked him when were we going to stop chasing the ball and actually consider the appeal, because as YOU ALL know, that ball never stops. There’s ALWAYS more doctor visits.
Then I started calling him daily, sometimes several times per day, to ask if he received my fax, or blah blah blah, I just made up dumb reasons to call. Finally by this past Tuesday, Nov 5th, he got enough of me, asked me to fax what I had to him from my sleep doc – which was previously not acceptable to him for whatever reason (stalling) – and he would turn it in that day for consideration.
He called yesterday, the 6th, to say they have to use the extension period (45 days) because there is no way they can consider all of it by the 17th of this month. Humph.
My ALJ hearing is soon for SSD! Apparently Florida is a very backed-up state, so my hearing is via video with the Santa Fe office, and I do have Allsup representing me. My rep says the decision period is usually 60-90 days, but may be longer due to the domestic dispute in Wash. D.C.
Is anyone able to tell me that it might come sooner?
Anyone ever heard or noticed that if a person is approved for SSD already, that P is more likely to give approval to an appeal?
Thanks and PBTG!
Michelle
Michelle,
I cannot speak as to the timing of any ALJ hearing with the SSA, but I can tell you that receipt of Social Security benefits contemporaneous to a claim denial and resultant appeal does increase your odds of being approved on appeal. As SSDI approval occurring during the 180 day administrative appeal process is additional evidence of disability that will be hard for Prudential to ignore when reviewing your appeal. That being said, it is still no guarantee Prudential will overturn any prior denial.
My boyfriend is permanently disabled thanks to medical malpractice. He applied for Prudential long term disability and was denied. He appealed, submitting 500 pages of medical records including X-rays, MRIs, etc., two independent medical exam reports, and a list of 18 doctors. Prudential has surpassed the 45 days to respond and has sent more forms to be filled out. Are they ever going to pay him? He is housebound, cannot work per doctor’s orders, and has no income. He worked for the same employer for 18 years and has an exemplary work record. Unfortunately, that employer is also a sovereign nation, so he can’t get the records for worker’s compensation either. Prudential is basically waiting for him to die.
Jennifer,
If they have not requested their legally allotted extension beyond the 45th day, and there has been no tolling of time, then the case could be ripe for a lawsuit now. Please feel free to have your boyfriend contact our office to discuss how we may be able to assist him.
I am currently out on STD in New Jersey, after hurting my knee. My company offers supplemental STD payments through Prudential. The day following my injury, I went to my primary care Dr, who wrote me out of work and sent me to the specialist. The specialist confirmed I require knee surgery. The soonest surgery date available is 6 weeks from the date I was written out of work from my primary care Dr. After jumping through a bunch of hoops with Prudential claim filing requirements, they confirmed the STD supplement is approved and told me check is in the mail. I’ve been looking on their website, and it shows my claim is approved, how many hours of time are approved, that nothing is needed from me, but the section that is supposed to show payments they mailed, is still blank. I get a call from my primary care Dr today who tells me Prudential called them, said they audited them, and they want to know why my primary care Dr has not sent them weekly updates to confirm I am still temporaily disabled. Prudential told my primary care that they will not pay me until I go see my primary care Dr once a week for them to send a factual update of my condition to Prudential, until I return to work. What kind of craziness is that? I see a lot of people on this site are saying Prudential wants monthly updates, and although that seems dumb too, especially when the anticipated return to work date is given to them at the start of a STD, wanting weekly updates seems more like a way to deter me further from pursuing thier pittance of a supplemental payment. It would cost me more in gas and co-pays than what they are saying they will pay as a supplement per week. And that’s another thing, I max out on what the State will give me. One would think ‘supplemental’ would mean it will make up the difference between what the State will pay me and what I make while I’m working, but according to Pruduential the amount of ‘supplement’ I [have to fight to] receive will equal about $9.00/wk! I thought ‘that cannot be right’ but no, they insisted it’s only $9.00.
C. Murphy,
The reason why Prudential is requesting weekly updates (as opposed to monthly) is most likely due to the fact you are paid the benefit (no matter how small) on a weekly basis. As such, they review entitlement to continued benefits each week and can therefore request weekly updates (with long term, it’s usually a monthly evaluation, thus requesting once a month). The amount of your benefit is most likely due to an offset created for your receipt of NJ state disability benefits.
Can Prudential discontinue benefits for not receiving information from the treating physician in a timely manner? I’ve been receiving LTD for 4 years from Prudential. They review my claim 1-2 times per year. I always send all requested information immediately, and I haven’t really had a problem with them. I received a call from the claim manager last week informing me that, unbeknownst to me, they have been trying to get transcribed progress reports from my doctor for the past two months. I asked her to please copy me on any correspondence because my doc’s front office is very small and they get backed up with these types of requests. She then told me the doc has 5 days to get the info to them or they will deny my claim. They have the records, they just can’t read his handwriting. Can they discontinue benefits because my doctor hasn’t responded fast enough? And if so, how do I proceed?
RA Mom,
Unfortunately, Prudential could deny the claim for lack of medical information to support ongoing disability. I would recommend you contact your doctor’s office to follow up with them about sending it, or in the alternative, secure a copy of the records yourself and forward them to Prudential.
I was diagnosticed with fibromyalgia, degenerative disk, sjogren ‘s syndrome. These symptoms cause me so many problems, that I can hardly function in a good day. I am appealing my denial. Should I hire a attorney now or wait until after my appeal is answered. I am waiting on the paperwork from Prudential.
Wanda,
It would be in your best interest to consult with an attorney before filing an appeal.
I have been on STD since Oct. 25, 2013. I pay for my Prudential LTD, not my employer. Prudential sent me a denial letter, which seems to be the standard practice. They claim the Dr’s statements/diagnosis, do not match up with my own statements of my diagnosis. I know what the Dr’s have been treating me for. I know what is wrong with me. I take daily meds for my disability. They made several incorrect statements in the denial letter. They don’t mention half of what I told them. I need to appeal. I am not able to sit or stand or walk without having pain and I am disgusted that I paid for 6 yrs for LTD and they turn around and deny me stating basically I am depressed and don’t suffer from Degenerative Disc Disease. That my Sciatic Nerve doesn’t cause me a great deal of pain. They do have at one of my MRI’s ( I have had 2) and the one CAT scan I had on my spine.
What steps do I take next?
Terri,
More than likely you will have to go through the Administrative Appeal process. Please feel free to contact our office to discuss how we may be able to assist you with same.
Hi, my claim with Prudential is currently pending an appeal made on June 1 2014. I know they have 45 days to make a decision. They denied my claim due there being no objective evidence. I worked for 5 years at previous job, have been on fmla since december 9 2013. They paid short disability till May 12th. I have COPD, fibromyalgia, major depression with bipolar tendencies, painful degenerative disc disease. I cannot work the previous job due to pain, inability to sit/stand/walk for extended periods, light/sound/noice effect my fibromyalgia and causes major stress triggering my fibro and bipolar. For last 5 years I have taken FMLA for 3-6 minth per year and Prudential paid STD each time. Each leave was approved by the same doctor now they don’t want to honor long term claim which is for the same reason of all my other leaves. Since each attempt resulted in the same routine, work till couldn’t take it no more, take short term leave try work again and so on; Dr. agrees it is time for disability now have to bicker with Prudential.
If this appeal is denied I will get a lawyer, but I don’t understand why an insurance company would be allowed to operated like they do?
Jenny,
What you are experiencing is not uncommon. Typically, short term disability benefits are administered by an insurance company, but paid out of the assets of your employer. When a claim transitions into long term disability the benefits are more often than not paid by the insurance company. As such, the carrier has a financial interest in your claim and more of an incentive to deny it. Please feel free to contact our office to discuss how we may be able to assist you should your appeal be denied.
I wrote before but since I still haven’t resolved my issue with Prudential and running out of money I probably will have to hire an attorney. Currently I am waiting on decision of appeal. I called them and e-mailed them told them I need decision by Friday. Is it best to hire an attorney first and then file a complain with Indiana Insurance License Board or do both?
How long does it usually take to resolve a case like this?
Jenny,
If your claim is denied a lawsuit is to be filed in Federal Court. The Indiana insurance board does not have the authority to award your benefits. In the event your claim is denied, then it would definitely be in your best interest to hire an attorney to litigate the case in Court. With respect to time frame- a trial date may not be set for 12 to 18 months. Litigation can be a lengthy process. Please feel free to contact office to discuss how we may be able to assist you.
Hi. On March 5th I had a blood vessel burst in my head at work and was rushed to emergency room from there. It was labeled as a aneurism and I immediatley had three surgeries to clip and fix the issue. I was out of work until June, in which I went back due to no further funds being available. I got very sick, got consistent headaches and where the shunt was placed in my body I can’t sit up or drive for long periods if time. The jib sent me back to Dr. and I took a cat scan. Dr stated he saw no issues but it still did not explain pains and headaches plus the memory issues. They took me back out work and job stated it’s best I attempt to get LTD. But when I did that I got a call from insurance company today stating claim was denied because cat scan was clear and they see no reason I can’t do my sit down job. I work at a call center. The Dr told me the stress from a job like that is dangerous due to my issue. I take emergency calls all day. My memory comes and goes. The headaches happen frequently and my neck and back stay hurting. What should I do? My job sent me documentation stating I needed to fill out a LOA or they could terminate me.
I was a fairly high level Sales Director who was on the fast track and making over $200k annually. This was about 10 years ago. Unfortunately, I began facing significant back issues about 15 years ago and toughed it out as long as possible. In 2001, I was traveling on a business trip and hit an animal on the highway thus totaling the rental car and seemingly leading to an acceleration of my back issues. I am told that I have severe degenerative disc disease and am not a surgical candidate due to the risk of worsening my pain. Anyway,I was being treated by a pain management physician who was attempting to preserve my job. However, in 2004/205 my boss required me to go out on disability. I resisted at first, but he was relentless. My pain doctor tried to keep me going as long as possible as I had a tremendous amount of stock that had not yet vested. Finally,he said it was necessary, as my job performance was compromised. Sometime after my disability was approved, both by Prudential and SSI,my family relocated to another state. It took me awhile to find a new pain, as several were trying to force me to either have a pain pump installed or a Deep Brain Stimulator stating that it was hard to believe that I could function on the oral meds that I was taking. I did not like those options and found a conservative pain doctor. I have been on a regimen of 80mg of Vicodin per day. I also need weekly visits to the Chiropractor as well as use of TENS units and massage therapy. We have been in maintenance mode for the past 7 years. The treatment helps me get off the couch however the side effects are bothersome, as I cannot concentrate, have sedation, memory loss, difficulty getting my thoughts across, etc. It is still better than the alternative. My dilemma is that after almost 10 years of disability, Prudential called me yesterday and closed my claim. They said that my IME states that I can sit for 6-8 hours and stand for 4-6, both are wrong. My job required extensive travel, detailed presentations, standing for long periods of time, quick thinking, budgeting, hiring and firing, sales projections, sales goals, etc. All of these are significantly hindered by my medications which is what my treating pain doctor has communicated to them. The IME doctor met with me for 45 minutes and hadn’t reviewed my file prior nor did he ask any questions about side effects nor daily activities. I’m stuck as we have depleted much of our savings and I have 2 boys who will be going to college soon. Will I even be able to pass a drug test? Won’t it create a liability if I were to drive a company vehicle while taking pain meds? I’d appreciate your thoughts.
Shanetra,
If you are not able to return to work your only option as it relates to your Prudential policy is to file an administrative appeal. Please feel free to contact our office to discuss same.
Mike,
In order to properly assess your options/rights we will need to see the policy that is governing your claim along with a copy of your denial letter when you receive it. In the meantime, please feel free to contact our office to discuss your claim in greater detail.
My question is: How many extensions are they allowed to request before they make a decision? I have an LTD policy with 30 day exclusion; I have applied for disability in June of 2014, and they still haven’t made a decision. Every time I call, I ask them what I can do to help. They say the need records but they never requested them. So I call the physician’s office and request them the records. Then I call again, and again and never receive any callbacks. Then when I finally get through several weeks later, the answer is always the same – we need more records. I’m completely broke, my health is deteriorating due to the stress of this all, and at this point I’d rather have them deny me and appeal then deal with anymore of this uncertainty because I don’t know how to plan financially. I have ME/CFS and meet disability criteria based on my labs per CDC/SSA guidelines. I’m a physician myself and I know for a fact that all the information that they need is already there. Are they allowed to continue to play this game indefinitely?
Iiirina,
If your policy is governed by ERISA, Prudential would have 45 days to render a decision on your claim with the possibility of a 45 day extension. If there was outstanding information required to complete a review then the timeframes could be tolled. That being said, an exorbitant amount of time has passed – please feel free to contact our office to discuss in greater detail.
I received overpayment from SS as a result of SSI award. Prudential and Allsup have provided me with four different accountings of how much of that payment is to be awarded to Prudential as backpayment for LTD disability benefits.
I have requested itemized account (in writing) from both of them to no avail. However, instead I receive calls every day from Allsup.
If I do finally receive itemized from Prudential, can I bargain/settle with them on the award amount I believe is accurate? Is this negotiable? What assurances do I have from Prudential that the will not hold this as prejudice going forward (as they are providing me with reduced benefits that are to be reviewed early 2015 for continuation)?
Recent,
Prudential will be responsible for providing you with an accounting of any overpayment owed. Unfortunately, insurance companies do not typically negotiate as to amounts of repayments.
Hello. I am wondering if I have any recourse for a STD denial as most of the comments above relate to LTD. I was diagnosed with a reactivation of mononucleosis in April and was out of work for one month, with STD payments the entire time by Prudential. Then in June I began to feel worse again and was taken out of work on June 22, 2014 with mono and an additional diagnosis of Lyme disease. (the Lyme diagnosis was later withdrawn as I didn’t have enough positive bands) Prudential again approved my claim. Then, on August 24th, they stopped paying me. They denied my claim on September 24th and it went to appeal. Today (4:30 on Friday afternoon, of course) Prudential called to say my appeal was denied. Since June, whereas the Lyme diagnosis was withdrawn, I have received additional diagnoses of: fibromyalgia, carpal tunnel syndrome, peripheral neuropathy in hands and feet, osteoarthritis in both hands, high blood pressure, depression, anxiety, demyelinating disease and decrease in memory as well as a transition to “chronic active Epstein Barr” from the plain mono diagnosis. Their denial focused on autoimmune disease tests that came back normal rather than all the ones that came back positive. I have yet to receive my appeal denial letter as apparently the determination was made today or this week sometime.
My questions are: Am I done? Do I only get one appeal with Prudential? I was told STD wasn’t covered by ERISA so can I sue? My rheumatologist has me off work for two more months and I am now 12 weeks without pay. Ironically, my doctors have all said that the financial stress placed on me by Prudential is hindering my recovery efforts. I can’t kick the mono. The drugs to help me sleep don’t work well and I wake up exhausted each and every day. My entire body is in pain and I am allergic to pain meds. I can’t pursue the massage and aqua therapy recommended by my doctors because we can’t afford it. I also have a long history of migraines, cervical and lumbar spine issues and chemical sensitivities. My primary concern is whether I have any recourse at all now that my (first) appeal has been denied.
Oh and by the way I purchased a supplemental policy through my employer that pays 60% of my salary if I go on LTD whereas the company only pays 50%. I believe they have extra incentive to reject my claim because I purchased the supplemental plan. If I have recourse for the STD denial please advise and I will contact you ASAP. Thanks so much.
Prudential Hell,
Prudential typically provides a voluntary level of appeal. Following the denial of the appeal you would have the right to bring a lawsuit under ERISA to secure benefits at this time-however, I wouldn’t necessarily suggest that at this time as the rules for litigation under ERISA are very restrictive. If your appeal did not provide adequate evidence of disability due to your diagnoses and you were to file a lawsuit now, under ERISA you would not be allowed to supplement the administrative record with additional information. Please feel free to contact our office to discuss how we may be able to assist you.
I have been fighting for quite sometime with Prudential long term disability that I have been paying for the last 11 year of being with my company. I have been in the hospital several times do to stress in fighting with them all of the time to get another check. It is always the same. We are reviewing your records at this present time and will be in contact with you soon. I was supposed to receive one more check for the month of November and was given a letter from them saying that they have over paid me in the amount close to 6k. I am extremely furious that they have the gall to do this to me. They have given me bleeding ulcers and have been put in the hospital at one point due to a rep from prudential coming to see me at my hospital bed. I was so angry at how I have been treated by the rep, that I opened up my mouth and told her that maybe I should just open up my own abdomen to show you the debilitating disease I have that will eventually kill me. I know that my years are not very long. But how can a billion dollar company get away with this?
Dalene,
I am sorry to hear of your troubles. What is the basis of the overpayment they are asserting? Please feel free to contact our office to discuss your situation in detail.
I was coerced into doing something that I later found out was in direct violation of federal law and the 1974 constitutional privacy act.
I was blindsided and put in am extremely uncomfortable situation at my SS office, pulled into a private room and until the office manager realized that Prudential had knowingly asked me to attempt to break the law, was under a lot of stress and duress.
Thankfully, the office manager clearly understood that I’d been forced into doing something that I didn’t know was a serious violation and formally documented the event, providing a letter that stated that if Prudential ever tried to gain access to another persons SS claim information that they would be subject to the full force of federal law.
This letter caused Prudential to back off in extreme haste and state that they would not ever pursue the avenue they were trying to go down.
My old employer Microsoft is not aware of this arrogant, brazen action and I’m hesitant to notify them in case they pass the buck back to Prudential and cause them to retaliate against me and make my already difficult life even more difficult.
A trusted contact at Microsoft says that since they are the owner of the policy that they would absolutely want to know about this as it’s something that could very negatively impact their company reputation if it was to get out in the open, but I’m not sure I can trust them to look after their disabled employees or instead just let Prudential deal with it, which I’m fearful of due to their brutal business practices? I’d like to think Microsoft would do the right thing in protection of their loyal alumni.
Not sure what to do? Advice appreciated.
Can Prudential reduce their burden in an ERISA LTD policy for the sale of private investments (stocks/shares etc.) that have nothing to do with employment or wages of any kind?
The IRS seems to report the sale of investments as “credits for additional earnings” which Prudential assert they are entirely entitled to use to increase their offset.
If this is the case, then selling any investments to try and help with a disabled persons tough financial situation would only add further hardship and allow Prudential to continue to lower their burden to a point where the policy would be potentially worthless.
Can they do this?
Jane,
What can and cannot be considered sources of “Other Income” subject to offset under a policy will be set forth in a policy.
I’ve been on LTD for over 4 years. I was just denied review of the SSA Judges denial by the SSA Appeals Council in VA. I know if I would have been awarded SSDI then Prudential would have gotten all of the back monies. What is likely or your experience at this stage regarding what Prudential might do once they learn the SSA Appeal Council has denied me a review further? Can Prudential make me reapply all over & start from the bottom again applying for SSDI?
How likely after learning I’ve been denied at the Appeals Council level is it that Prudential will continue my monthly LTD payments?
Will they follow suit due to the fact that the SSA Appeals Council has denied me & stop LTD payments. Perhaps you’ve had experience as to what occurs at this stage with Prudential in the past?
I have an attorney for SSDI & another for LTD benefits currently. I wanted your firms professional opinion or anyone else’s experiences also. I don’t see any comments on this type of situation at your website or blog.
I greatly appreciate your opinions.
Thank You,
Steven
Steven,
There does stand a chance that Prudential will conduct a review of your claim to determine continued eligibility for benefits in light of the fact the SSA has denied your claim through the appellate level. If your claim for benefits is in the “any occupation” stage the chances would increase further. As you are represented by counsel, any specific questions about your claim will need to be directed to him/her.
On 1/12/14 I was called into my HR department and handed a letter stating that I have been observed experiencing extreme fatigue and sleepless due to my medications and medical condition. I was given STD paperwork and immediately went to my PCP to have the paperwork filled out. My medical condition is severe arthritis in both TMJs. On 4/15/15 I will be having bilateral joint replacements. I am trying to have my STD claim approved for leave starting on my last day of work 1/12/15 through my surgery recovery estimated at 5/30/15. My claim is still pending because Prudential keeps requesting more information from my PCP and surgeon. I am afraid I will be denied. I love my job and if I could have my surgery tomorrow, I would. I do not want to be on the medications I am on which is why I have decided to have replacements. I am terrified this will not end well. Can you help me? Will I be denied because of a preexisting condition? I am only in need of STD until I recovery from bilateral joint replacement surgery. Please help me understand my options.
Lynn,
Please feel free to contact our office with a copy of your disability policies so we can best advise you as to concerns relating to pre-existing condition provisions as well as to discuss Prudential’s current review.
I just want to state that it’s sad when your husband has worked for 31 years. Most of these years was as a certified mechanic and then a retail manager. We aren’t your live off the government type of people. We thought we were being responsible.
He purchased this “insurance” in case something happened to him and something did happen to him. He also purchased a life insurance policy for the kids and I which he lost. A lot of things happened to him all within the time frame of about 14 months. His claim was just terminated today.
My husband has 8 documented disabilities and while these disabilities were being discovered we found out he had kidney cancer which meant he had to go through surgery for that. It was never our intention for us to be depending on these payments. My husband was being a responsible provider, or so we thought, by purchasing these extras in the event that something should happen. Thanks to this insurance company that uses ERISA my family of 4 will probably be living under a bridge soon. I wonder how these people sleep at night. I don’t know how I’m going to pay my rent, buy groceries, get my son’s medications, I know I’m ranting. But these companies are horrible. My husband just threw his money down the drain…
Jo-Jo,
I am truly sorry to hear about your situation. Please feel free to contact our office to discuss how we may be able to assist your husband in appealing the denial of benefits.
I have been on LTD for over 5 years, and was finally approved (fully favorable) for SSDI last year – had to pay the entire back payment lump sum to my carrier. My LTD carrier offered to “help” me manage my relationship with SS, and when I declined they then sent a form which they want me to sign that essentially gives them full authorization to all of my SS matters directly with SS without involving me. I am not at all comfortable with this and wonder if I have to give up my constitutionally protected rights when I have no problem sending them any updates I received from SS – the only things are COLA’s, which according to my policy with Prudential they are not allowed to reduce their offset by. SSDI payments are not earnings, and I’ve clearly confirmed that any future COLA’s by SS will not be used to offset Prudential’s payment. I don’t feel that I should have to sign this request?
Tony,
It is certainly your prerogative not to sign the release, but you will be responsible for sending any additional updates. Additionally, you may be eligible for a lump sum buyout from Prudential given your claims history. Please feel free to contact our office to discuss if you are interested as to same.
Prudential sent me a letter stating that I have been over paid of 5k and would need to pay that back. Then I will be able to receive the rest of my checks that are due to me. But I don’t feel this is right. So every month now I receive a letter each month from Prudential showing my check I am to have, but it shows all the deductions taken out I supposedly owe them and it always shows a 0 amount every time.
Dalene,
What is the nature of the overpayment? They should have put it in writing – if not – demand it as such. It is not uncommon for a carrier to apply the monthly benefit to an overpayment and then begin the benefit once it is satisfied.
Hi, I was on LTD with Prudential since 2009 and in July of 2014 they cut me off. Thinking it was ERISA but I worked for a school dist. so it’s not. Then they ask for a IME and have a guy trying to film me 3 months after they stopped payments but they all ready stop all payments in July 2014? Can they use the new info to help them with cutting me off? I live in Utah. The first time they cut me was in 2011, they sent a paper with three jobs on it. They themselves said I could not do those jobs, they put me back on in 2011. This time in 2014 the same guy reviewed my case as in 2011 and sent the same paper with the same 3 jobs, but now they know its not covered under ERISA. By the way, I went to voc. rehab in 2010, was on their program for 3 years, they and I ask for help from Prudential! They refused to help. I did days of testing and UT voc. rehab could not retrain me and could not get any doctor to release me to work, but I tried. And they know it and have all the paper work. What to do? Thanks for all the good info. You guys are very good at what you do!
D,
Your claim history is very lengthy, it would be best to discuss over the phone. Please feel free to contact our office to determine how we may be able to assist you.
I have been on LTD with Pudential & SSDI since April, 2011. They have denied my claim twice already; in both cases I was fortunate enough to have my doctor speak to them directly and get reinstated.
My issue is this: I expect Prudential to once again denie my claim. They asked again for my doctor and me to complete their questionnaire. I mailed the repsonses from me and two of doctors on 3/25 certified USPS delivery. Today I received a call from Paula saying they didn’t recieve my completed form – not surprising with a April 2, 2015 due date. Paula left me a message saying she only recieved a cover letter with my notes scribbled on the side and no completed form.
Here’s the kicker – I mailed my competed form with a copy of one my doctors completed form and an original form completed by another of my doctors – in the same 2 day envelope stapled to the cover letter with my notes. In the universe we live in it is impossible for Pru to have received only the cover letter.
When I returned Paula’s call she was not available (of course) and I spoke with Gina. She told me this happens all the time and to call back by end of day tomorrow to see if the pages had been logged into their system.
After speaking with Gina I went to take a shower, as luck would have it Paula called and left a message saying what I been told by Gina was not true. She stated she couldn’t believe I wasn’t there to take her call and wondered why that was since I had spoken to Gina only minutes before.
My concern is Pru will try to discontinue my claim 4/2 saying I didn’t supply them with the required papaer work.
My question is: How many clients have been lied to and intimidated by their tactics and do I have any recourse? Fortunately I kept copies of everything I was sent. But now I have to make more copies and overnight them again to avert missing the 4/2 deadline.
Background to my disability; I suffer from Systemic Mast Cell Disease for which there is no cure, along with Chronic Pelvic Pain Sydrome for which I take 21 different medications daily to try to control both.
Mast Cell disease is a very rare disease and I am fortunate enough to have one the world’s leading doctors @ Brigham & Womens in Boston treating me. Systemic Mast Cell disease can be triggered by a host of different triggers such as stress, heat, exercise, food and even sunlight just to name a few. The disease can attack any part of my body from my skin, diarreaha, breathing and even severe brain fog. Leaving me unable to function until the episode has run its course.
From your website it is clear I am not alone with having to deal with the despicable tactics by Prudential, but is there anything I can say or do which might help prevent this from happening over and over again? I am also afraid if they know I am reaching out to you, their tactics will only increase in severity and multiplicity.
Thank you!
Glenn,
Has there been any change to your claim? Did they confirm receipt of the documents? With respect to intimidation tactics- as you are well aware, Prudential will request updated claim forms, and are within their rights to do so. Your only legal recourse against Prudential would be to secure unpaid benefits, so there is no legal remedy for the way Prudential is making you feel. As there is a history of problems, I would suggest that you mail claim forms via certified mail or some other mail source that requires the document to be signed for. Additionally, since you have been on claim for quite some time, Prudential might consider a lump sum buyout of your claim. Please feel free to contact our office to discuss any of the information contained herein.
I have been on STD disability since 11/17/2014, for MS. As of a week ago, I did not get paid and my STD benefits were suspended. I called to speak with the claim manager whom stated they suspended the coverage as they did receive any medical records. The problem with that is, my doctor only specializes in this disorder and understand how imperative it is to answer records request. I spoke with a nurse at my doctor’s office, and she informed me there were never any requests received on their end, which is why the records were not sent. Turns out they were sending requests to the office line and not the fax line. My application from November contained the correct information, including the correct fax number, and I signed the form they told me too in order for my records to be released. I can’t understand why I am being penalized for their incompetence, I’m the one whose sick. No claim managers called an told me of this problem until they suspended my benefits 4 months into the coverage. Now they’re telling me it may take up to a month to rectify the situation. I already missed one pay period and soon to be a second. I cannot find any logical explanation to how this is my fault. Also, the claims manager informed me my LTD will probably be denied due to the look back provision as I was not with my employer for a year. I was diagnosed originally on June 6th, and started my job June 30th. I did not start any treatment until the end of July, I was not under any routine care from a physician, and my condition did not worsen till November. The LTD did not get denied yet, and my STD doesn’t expire till 5/11/15. Is there anything that can be done about this situation? It is causing a terrible financial burden, and the stress of the situation as a whole is exacerbating my symptoms.
Jay,
There does stand a likely chance that your STD will be reinstated based on the medical records. With respect to the LTD Policy, from the dates you provided it does appear that your claim would be subject to a pre-existing condition provision found in most ERISA based disability policies. If you have been covered under the policy for less than a year when you file a claim it will trigger a pre-existing condition evaluation. The typical language reads that the carrier will review the period 3-6 months prior to effective coverage (or employment) to determine if you were diagnosed, treated for or received medical attention due to the condition you are claiming disability for then the condition is deemed pre-existing and not covered.
If I am unable to pay the full lump sum of overpayment to Prudential, can they just with hold my LTD checks till it is paid off?
Stacy,
You can certainly approach them for a repayment plan.
Long story short, I am at the appeal process for a denied claim. Every thing that was said in prior references above has happened to me. My Therapist and Supervisor for Behavioral Health spoke to my claims manager over the phone and the Supervisor requested a form from Prudential that could possibly give them the information they need. I am financially destitute and severely depressed along with the PTSD already diagnosed. I also suffer from degenerative lumbar and disc disease. I do not believe that Prudential was given my neurology reports so I obtained those records and am overnighting them myself. However, this still may not be enough information. Prudential requested records from November 2014 up until June. The hospital provided information up until March 2015. My therapist sent a letter to Prudential via fax confirming the diagnosis was the same and that I am still being treated for such. But this was not enough for the Prudential clinicians. My therapist filled out a 24 page form of essay questions. What is the appeal process.? Is there a specific form I have to fill out? exactly what am I to provide with the appeal letter. Prudential already has the most updated medical records available. Since my original claim, I have been diagnosed with diabetes 2 and have been suffering from chronic pain due to my back and am still suffering from migraines which are dibilitating. There are days when I can not focus, or concentrate long on anything I am irritable can not walk stand or sit for any length of time, suffer from blurred vision and have very little range of motion. This all seems trivial to some of the complaints I have just read. However, I can not work. What else can I do. Is it possible to get a copy of my policy also?
Gail,
Your employer (or former employer) is responsible for providing you with a copy of your policy. I recommend you request same in writing from your HR department. With respect to your appeal- please feel free to contact our office and discuss your claim and the steps available to you at this time as it relates to your pending appeal.
Dear Greg
….I have been on LTD through Prudential for nine years due to a rare brain/spinal cord Disease. They continually harass me and my family with phone calls, paperwork, I have caught several videographers following me over the years. My records have always been open to them. I have complied with every request. I recently went to work doing voice overs for a local radio station. I can only do 2 hours and that is it. Then I am back into bed most days. They are now starting to harass my employer by asking for 3 full print outs of my pay-checks from Jan til now. My family and I are exhausted with this continued harrassment, even though my rare brain diagnosis has made it very clear I will NEVER be able to go back to work full time. My limit I can make per month is $900 dollars before they can deduct from my LTD paycheck and I am no where near that figure. I think $600 dollars in one month is the most I made, however, I suffered a rare brain attack from doing too much (according to my Neuro) it’s like a switch flips off. If there is ever a class action suit, please let me know.
GG,
Unfortunately you are not alone as it relates to ongoing claims review – especially when an insurance company knows there is some level of work functioning (no matter how small). If you’d like to discuss how we can assist you with monthly claims handling please feel free to contact our office.
Question,
Waiting on LTD approval or Denial, been 90 days in one week, keep giving themselves extensions.
The question I have is I have Attorney working on my Social Security Dissability. When I receive it will I owe Prudential moneies back for the time that I am double paid, from Social and Prudential.
That is assuming I get approved for LTD.
Gregory,
You will be responsible for the repayment of any applicable overpayment on account of the SSDI award for any period of time that Prudential was (does) pay. That being said, if you have submitted all applicable information to Prudential then a claim’s decision should have probably occurred by now. Please feel free to contact our office to discuss.
I stumbled across this site and felt like I could release some of my problems with Prudential. My heart goes out to all that have or are suffering because of Prudential and their antics.
I was diagnosed with Menieres Disease in 2002. Saw many ENT’s throughout the decade and each had their own opinion as to how to treat it. All theories, no cure. A few episodes a year but I got thru life. I loved my job, working with people and the general day to day with people. Made 6 figures, I was happy.
In 2013 however, the vertigo was daily, I was couch bound for 4 months, went thru 3 treatments of gentamicin injections, and finally a labyrinthectomy (to remove the inner ear which makes me deaf but stops the vertigo). The laby stopped the vertigo but all other symptoms were still there. Imbalance, nausea, dizziness, cognitive issues and others but wont get into all the symptoms.
Feb 2013 I went out on Short term. STD with Prudential was a complete harassing nightmare, constantly holding checks and requesting redundant information time after time. Once I went to LTD I was sent a letter stating “I have been approved until I was 65 to be paid and my life insurance premiums would also be covered till im 65 as well as long as I meet the “terms of disability”.
In May 2014, I noticed the “keystone cops” following me for 3 days. If you’ve ever seen a cop show on tv, you know these guys are following, they made it so obvious. June 2014, Prudential says my activity (driving 1 mile and bringing my dogs to the park) was enough to show them I was able to return to work. They said I “had control of 2 dogs”, yes I did, with a remote control since they have electric collars on. Also said I threw the ball with the dogs, Yes I did, with a “Chuck-It; a long handled tennis ball throwing device) not much effort involved while leaning on my walking stick. I would love to see the recording, there’s no way I am stable throwing it, lol.
The also tell me that is my last payment as my claim has now been denied. I request all of my notes they have on me (9.5lbs) and we hang up. Wow. The only activity I get during the day is going to the park with the dogs for an hour and that is enough for them to deny me? This is BS.
I have 2 neurologists and a Johns Hopkins report saying I am 100% disabled from working consistently in any given day.
I am waiting for the outcome of the appeal now as they have already said my Life Ins has been reinstated yet asked for an extension on the disability portion. One of the qualifications of the life insurance is that I must remain disabled or they would cancel my policy. So I cant see them denying my disability unless they redacted my Life Ins Policy.
My real anger issues with Prudential are :
They, without real notice just deny coverage whenever they want, because they can.
They, act as if we can just jump right up and go get a job to pay the upcoming bills, but we can’t.
They, act is if we were just fired or laid off from a job, like we can collect unemployment or something.
They, act like they can play God. Hey Prudential, YOU ARE NOT GOD!
Look, I understand that people are scamming the system and they should be burned. But for the people who really deserve it, they just don’t care. I understand that they don’t want to pay me $60k/year for being on their plan, I get it, its a business. But it’s what I signed up for and what they accepted at the time but the harassment and aggravation I get from them is unbelievable.
It has now been 15 months since Prudential has paid me. If not for the understanding and strength of my wife and her support (working 3 jobs while back in school for her masters) I don’t know where I would be.
So, Stephen, after all this on and on, I have a question for you.
In all the readings I have been doing online about Prudential and being stuck in this situation myself for almost 15 months now, once this appeal is complete, verdict going either way. Can I bring them to Civil Court and have this resolved once and for all? Meaning they can’t keep denying my claim on some bogus PI statement that can be easily dismissed by explanation? I do not want to go through this every couple of years.
Art
Art,
Unfortunately, until Prudential renders a decision on your appeal no legal action can be brought- and any action that could be brought can only be to secure unpaid benefits. A judge has no power under the law to award benefits beyond a period of unpaid benefits. Essentially, as long as you are covered under the plan you will be at the scrutiny of Prudential. That being said it may be possible to secure a lump sum buyout of your policy. Please feel free to contact our office to discuss your claim in greater detail.
I have until 12/10/2015 to file a grievance. In march of 2013 I called my private LTD company, Prudential. I needed in writing the end date of my LTD to be used as a legal document on how long I will receive those funds so myself and my soon to be ex-wife could come to a monthly payout to her that we both could agree on for me to pay her off for my son’s car. I was told over the phone and sent a letter describing that the last day of my LTD would end on 12/10/2016. On 06/11/2015 I get another letter from Prudential Ins. Co. stating that my LTD would end on 12/10/2015. I called Prudential and spoke to Sara who promised me a supervisor would call me. It has been 8 working days and still no call from a Prudential supervisor. You don’t know what a spin my financial plan for that money that was supposed to keep coming until 12/10/2016. This has caused so much stress on me sometimes I just breakout crying. I am a 64 year old permanently disabled man in need of legal help.
Lawrence,
Please feel free to contact our office. We will need to see a copy of your disability policy as it would detail the maximum benefit period for benefits payable on your claim.
I am the wife of a recipient of prudential ltd who also receives SSD. My husband is not cognitively able to do correspondence such as this so I do it on his behalf. My husband has atypical tuberculosis unresponsive to conventional treatment because having the treatment almost killed him. he also suffers from occipital trigeminal neuralgia for which he receives direct injections as needed from his neurologist. He has herniated discs in his spine–in the neck and lower back and suffers chronic pain from this. He was injured in a car wreck years ago that has only gotten worse with age. he sees a pain management dr for this condition. it was his disabling condition from the military. he also has diabetic peripheral neuropathy in all of his extremities. My husband doesn’t drive due to a history of multiple TIAs as well as sedating side effects of his medications. he developed these TIA’s after he was diagnosed with avascular necrosis. he has since had both hips replaced. He has NASH that is stable at this point. he also is being treated for anxiety and depression. it’s been a year and prudential hasn’t asked for a review. is there something I should be doing that will make his 2 year review approved? I realize that the work standard is really strict. Is it more strict than that of SSD?
Deb,
Please feel free to contact our office to discuss your husbands claim. There is a lot that goes into any review for continued benefits into the any occupation period and a conversation would probably be the best avenue to discuss.
What I would like to know is can a Pudential doctor change your doctors restrictions. From the Acitvity of Daily living questionnaire. They ask your doctor to fill this for out and then you get your denial letter and then their doctor has changed them to fit Prudential needs. Is this allowed. I need to write an appeal letter and need to know the legal aspect to this issue.
Chris,
Prudential’s doctor is able to formulate his/her opinion as to restrictions and limitations, which are quite often- as you have experienced- different than those of your doctors. Please feel free to contact our office to discuss your denial and your appeal rights.
I had an accident at work on 06/14/2014.
After a few “rounds” of Physical therapy and 3 epidural cortisone shots, doing everything that I could do to avoid back surgery, I had no choice and on Sept. 23rd 2015 I had back surgery. I worked while in pain until July 21st 2015 at which time my Doctor said that I should consider surgery and that I should not lift more than 25 lbs. At work I have to lift 80 lbs and there is no “light Duty” so I “went on” Short Term Disability.
January17th of 2016 my Short Term. Disability “runs out”.
Prudential said that I am not eligible for Long Term Disability do to a Pre-existing condition because… “I was prescribed hydrocodone during a 7/3/14 Doctors visit for my back. I filled the prescription for hydrocodone on 7/7/14, which was during the pre-existing condition period, which was in treatment for your back condition; therefore your back condition has been determined to be pre-existing”. I said; the date of the accident was June14th 2014.
The date of the Doctors visit was July 3rd 2014. July 3rd is after the accident that lead to surgery. The contact at Prudential simply repeated herself and said “I hope this helps”.
She said that if I was with Prudential for a year, Pre- existing conditions would make no difference. I would be covered. I understand this; I was only with Prudential for 8 months. I had the accident on Saturday June 14th. I visited the hospital E.R. on Monday June 16th. “E.R., orders were to follow up with my family Doctor. I did on July 3rd, which was as soon as my Doctor could see me and is when he prescribed Hydrocodone. Something just doesn’t seem right! I want to appeal the decision.
James,
Please feel free to contact our office to discuss your claim and review the denial letter.
Why is it we have paid for disability insurance from Prudential and your never told you would have to fight them more than social security. I thought this company was suppose to help you that’s what your paying for. Why do the attorneys allsup get more than a SS attorney you hired yourself would receive. I’ve read it’s twenty five percent. Allsup wants almost all of the back pay. What entitles them more than a outside SS lawyer receives? It seems their above the law.
Ann, allsup would not be paid more than an SSDI attorney of your choosing. The SSA statutorily caps fees that can be paid out on a SSDI claim.
I am a disabled RN who has had seven neurosurgeries, including 2 recent brain surgeries, over the past 2 years. Prudential requires me to complete these Activity of Daily Living questionnaires every 3-6 months. They are also requiring that my physician complete a Capacity questionnaire. My primary physician doesn’t handles these at all. He refers me to PT. Prudential refuses to accept it if PT fills it out. My neurosurgeon is hundreds of miles away from me. What on earth can I do?
Jamie, it is not uncommon that a PCP won’t fill out a capacity questionnaire. One potential solution is to ask your PCP to send you for a functional capacity evaluation (performed by a PT) that documents your physical restrictions and limitations as it relates to the ability to work in a classified Department of Labor physical demand level (sedentary, light, medium, heavy, very heavy). With the results of the exam your PCP could complete the form using the testing as the basis for his opinion. Additionally, given the severity of your conditions Prudential may be willing to negotiate a lump sum buyout of your policy. Please feel free to contact our office should you like to discuss further.
I have Prudential insurance through my job and it has ruined my life to depend on them for benefits. Yet in still it wasn’t a problem for them to take premiums from my check weekly for coverage. I’ve been out of work since 2/8 and dr disabled me 3/24/16. They have denied me even with MRI record dr statement and hand surgeon information. They have caused me to take many losses. I must’ve spoke to at least 20 reps and manager and still haven’t heard anything. In fed up with not having any income in 3 months. Working at an assembly plant requires both hands so if I have a tear in my wrist that’s extremely painful. Can I go about suing them for loss wages and emotional distress?
Prudential is the worse insurance company in my experience to deal with. I applied std but condition turned into ltd. I paid into both through my job every week. Their very nonchalant and unprofessional. They care nothing about the people who keep them in business. Everytime I called for rep claim manager or supervisor no response. They don’t keep you informed with correspondence regarding your claim via phone or via email. They keep giving me the runaround on my claim after denial and it coming up on 45th day. Their not helpful to their claimants financially or emotionally. These people has ruined my life caused me to lose everything n sent me to hospital for stress and feeling mentally sick. What can be done about them ruining people livelihoods and not paying on a claim?
Tosha, under ERISA your only actionable cause is for unpaid/owed benefits. Did you already appeal the denial of benefits?
To whom it may concern
I was denied on 2-22-16 and was told medical didn’t support disability. My dr disabled me 3/24/16. Submitted letter 3/29/16 to appeal and docs. Was told a decision will b made 5/12/16 it’s 45th day. I called today to check status n was told the supervisor would call back today. Haven’t heard anything all day from prudential or supervisor. It’s ashame hard working people pay them money for a service and can’t get help. I’ve been getting the runaround since February and had enough of the lies and runaround. They went from not having all paperwork to a clinician has to evaluate docs. The clinician doesn’t know the pain I’m feeling and I didn’t go thru this bs wen they took from my check. Why is ok for them to collect and not pay off? Why are they still in business after all the turmoil they cause taxed paying citizens? Is there any way I can complain to the bbb I want to express my dissatisfaction with this insurance company? I hope n pray to god I never have to deal with these people in life!!! They’re the worse and you couldn’t pay me to be insured other them. They lie as easy as they breathe not to pay off claims.
Anonymous, if they uphold the denial of your appeal please feel free to contact our office to discuss what your rights going forward are.
Anonymous, if this is your first appeal and it is denied you would have the ability to also file a voluntary appeal to secure benefits before having to file a lawsuit. Also, to clarify- you were denied 2/22/16, but your doctor didn’t find you disabled (or certified disability) till almost a month later- 3/24/16? Please feel free to contact our office to discuss your case.
Advertisements on my government job indicated that Prudential would supplement our disability plan, if we became disabled. My employer pays 50% of my salary Prudential’s contribution is suppose to be 10%. A couple years ago, I found out that I had a disabling medical condition. I struggled for two years, exceeding my FMLA time the second year, until I reached retirement age. My employer approved my disability request as did Medicare. Prudential is another matter all together. First they balked at doing an intake for my claim, it took several phone calls. Before receiving my attending physicians statement, I was barraged with questions about “what date I was returning to work” and received an invasive questionnaire about my KSA’s (knowledge, skills and abilities) and educational background. With due diligence, I researched Prudential, policy language, and their abuse of claimants online. The commentary here has been most helpful. Very thankful that I’m not completely dependent upon them. The policy cost me approximately $2000.00. Not sure if it’s worth fighting these corporate vultures for the 10%.
Miss, we will certainly review the denial letter and discuss your options with you so you can make an informed decision if you want to proceed in appealing the denial.
I have been on ltd since 2012. I have faced the normal plight dealing with prudential but still remain on their ltd. They didn’t have allsup file for ssdi for me. So, I proactively did myself, having no faith in prudential. I went through the whole process on my own, no lawyer. I was approved recently, having gone through all stages of the ssdi process. They have given me the back pay. So…..yesterday I receive a letter from prudential saying that they have overpaid me over twice the amount I was rewarded from ssdi. Their paperwork makes no sense. I am preparing to call them now to see if there is an error. I had figured that they could only collect 75% of the back pay. Also, my children have been on my wife’s ssi for six years. Seems like they are trying to figure my kids into it. Even then, that they may as well be asking for a trillion dollars, they are add likely to get that from as the number they are asking for.
Bill, please feel free to contact our office. We will be more than willing to review the letter from Prudential relating to the overpayment to advise how we may be able to assist you or what your options are.
I have a policy with Prudential, and this is the second time I’ve gotten a denial since first filing and getting approved. They first denied me during STD, got a lawyer, appealed, and won (after they took the maximum amount of time to decide, of course.) It’s been about a year since then, and they’ve terminated LTD leave (right after I got my initial denial for SSDI).
I have a question about their medical experts that I can’t find info on anywhere. Prudential used a doctor when they terminated during STD who said I wasn’t disabled. Months later, and an IME where one of the two paid-for docs said I was disabled, I’m approved. They used that same doctor to terminate me this time. Are they legally allowed to do that? It would seem to me that if a doc said I wasn’t disabled but others later found I was/Prudential reinstated benefits, he’d be a poor choice for future reviews. If this ends up dragging out to the lawsuit stage, I’m sure that’d be a mark against them, but I’m wondering if there’s any ERISA protection from that or something in case law where that was held against a disability insurer.
Shhhh, it does create the appearance of impropriety that their review was arbitrary and capricious, but more investigation into the file would be needed to determine to what extent. What is the status of your claim/appeal?
I’m currently going through the appeal process after my claim was initially declined . My claims rep would call me from home with kids and ppl in the background while discussing my personal info . Is this legal? Now after my claim has been denied and I’m appealing it her manager wants to contact me to talk about the complaint . Help plz
Beyond, please feel free to contact our office to discuss your situation.
Is there a class action law suit against Prudential… I will like to join that.. my claim was denied. After doing some research I see that there are many, many people being hurt by this Companies.. greed and they do not care for there customers… There has to be something we can do… these people/company are horrible.. and are causing great harm to others… What about this class action law suit… I am going to my Companies HR and I will not stop until they disband from this Company and stop using them… no one should suffer from this Company greed.
I was making almost 200k a year working at sea when I was shattered my legs in a car accident and messed up my legs to where I have permanent difficulty walking and maintaining balance. ( no way I can work on a boat in rolling seas). My policy gives me 80% of my previous income or 3500 a month, whichever is less. I’ll be coming up on the 2 year part of the “Own occupation ” clause of my policy and they said that would be wanting me to start looking for work in another occupation.
There is no way that I will be able to find a job making what I previously did. In fact they said I need to make close to 50 dollars and hour for them to consider me ” gainfully employed”. And yet I still expect the denial at the end of 2 years as a matter of their SOP.
If I get a job making 2k a month will they still have to make up the difference on the 3500? I will be able to work soon, but my earning capacity has diminished greatly.
Do they offer lump sum buyouts? Can I move out of the country and work elsewhere and still receive payments?
Jameson, Prudential does negotiate lump sum buyouts, but usually not until the two year occupation changes and Social Security disability is in place. With respect to your questions regarding what your policy allows for- we would need to see a copy to better answer your questions. Please feel free to contact our office to discuss your claim further.
To whom it may concern: I already collect LTD… they needed to do a adjustment… so they asked for proof that me and my wife is seperated and my kids live with and that she collects thier SS checks. I supplied that information. They said see that they haven’t lived wit me since 2005 or 2007. I collect $100 a month from them, now they saying that over the years my SSDI check went up a few dollars so I owe them $300 something dollars and they subtract $19 a month to pay it back… so now I get $81 a month from them. Am I not intitled to a back pay from when my family wasn’t living with me and it was adjusted to $100? If you can help would be greatly appreciated.
Sincerely
Mitchell
Mitchell, you need to review your policy to determine if Prudential is allowed to reduce by any Cost of Living increase to your SSDI? Or if the increase was due to the SSA re-figuring your benefit and paying the correct amount. Furthermore, most policies have what’s known as a minimum monthly benefit amount – typically $100 that they will have to pay regardless of offsets – confirm that amount with Prudential. Unfortunately, the policy would allow them to reduce the DSSDI from your check even if your children are not living with you. If you are paying child support you could explore your rights to have that re-evaluated based on the amount the SSA is paying to your children in the care of your wife. You would need to consult with a Family Law attorney to explore your options.
Prudential is the most dishonest and immoral company ever! My husband has been on LTD with them for a few years. In December they sent a letter asking for $11,000 back. He had been received his disability based on 60% of his gross wages. Now they say it should be box 5 of the W-2. Box 5 deducted for voluntary health, dental, vision insurances. NOWHERE in the policy does it state that box 5 is used. It states 60% of monthly earnings. I have appealed and was denied. I am going to appeal again. I have worked in payroll – gross wages means the total earned before any deductions. It seems to be discriminatory to deduct for your voluntary insurances. How can a company sell a policy saying 60% of monthly earnings. If a family of four with family insurances and a single person of one with single insurance rates (health, dental, vision) were to make claims – they would get disproportionate amounts of disability income. At my wits end.
I filed my claim in January and two weeks ago was told I needed more medical records. So I had to go out get all my records, scan them and pay to send them.. A few days later of course they were unreadable. So sent them again.. So now they have everything. After speaking with a supervisor because I have been getting the run around. She told me ai would have a decision Friday. Well the claims manager told me it will be 5 more business days.. I have been a cop for 15 years last July I got breast cancer and the side affects from the surgery and the hormonal chemo meds makes it hard for me to walk at times, all my muscles cramp and hurt, my right arm doesn’t work most of the time due to lymph node removed.. Cant lift alot now and definitely cant lift ot above my head.. I now also suffer from depression, anxiety and panic disorder.. I feel like they are giving me the run around because they dont want to cover me.
Cancer patient, a decision on your claim should have certainly been made by this point. Hopefully, the claim will be approved without need of legal intervention, but please feel free to contact our office to discuss your situation further.
My housemate Nancy was awarded a permanent lifetime disability by the State of Tennessee from an industrial exposure, when she lost 70% of her lung function. Recently Prudential behaviors towards her shifted. I helped her document the incidents, and then urged her to file a compliant with the State of Tennessee Insurance Commissioner. They forwarded her complaint to Delaware (where Prudential LTD is headquartered), who a month later still has not contacted her. Reading through your complaints gives me the impression that Prudential continues to violate patients perhaps because the Commissioner’s office does not have the resources or lacks authority to protect patients against these continued breaches of contracts and violation of ethics.
I am curious to know what your experience with the Delaware Insurance Commissioner office has been.
Just called them and now they need another week and a half so they can do an occupational review on my job description or something like that. Even though the case managers boss told me I would have a decision today. Now the case manager will be off all next week and Im still broke.
DL, many state insurance commissioners will not get involved in ERISA governed disability insurance policies as these polices are governed under federal law. Please feel free to have Nancy contact our office if she would like to discuss her concerns with Prudential.
I have a neighbor who received a life insurance payment from an insurance company, I believe Prudential, at his death. She got over $80K and now they want back $60K because they said an age reduction in benefits should have been done when he turned 62 and it wasn’t. He died somewhere around age 80. Does she have to give back the money?
Art, without seeing the applicable policy we would not be able to determine what her rights are. Please feel free to have her contact our office to discuss Prudential’s letter and to review the policy.
I’ve been thru all the same things everyone complains about here. I’ve always been one step ahead of their game due to research. I just got notice they are stopping my payments. No big loss due to the little amount they pay me. Fair? Of course not but it’s just not worth fighting. It would cost me more to fight it than to let it go. It just infuriates me knowing what I paid them over the years and the way I got treated when I needed it. I would have been better off just banking the premiums. Good luck to all of you.